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  • Name: CHARACTERIZATION OF BREAST LESIONS SEEN DURING MAMMOGRAPHY AT UNIVERSITY OF NIGERIA TEACHING HOSPITAL ENUGU
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ABSTRACT

This research was carried out to characterize the variety of the breast lesion seen during mammography at UNTH and to establish the age distribution of the lesion at the time of presentation.

This research is non descriptive study,222 secondary data was obtained from the patient request card and patient mammography result.

This result shows that benign tumour is more common in our locality and it sub classified into fibroadenoma, cyst, lipoma mastitis, and it is presented at age of 41-45.this shows that benign tumour is more common in early age than malignant tumour which is presented at the late age.

The above findings  shows that variety of breast lesion is seen in our locality and all hand should be on deck to ensure that its incidence death rate is reduced.

 

 

TABLE OF CONTENTS

Title Page……………………………………………………………. i

Certification………………………………………………………….   ii

Dedication………………………………………………………….. iii

Acknowledgement………………………………………………… iv

Abstract……………………………………………………………..  v

Table of content……………………………………………………  vi

CHAPTER ONE

Introduction………………………………………………………… 1

1.1 Statement of problem…………………………………………         3

1.2 Purpose of the study………………………………………….         3

1.3 Significant of the study……………………………………… 3

1.4 Scope of the study……………………………………………. 3

1.5 Literature Review……………………………………………….        4

 

CHAPTER TWO

2.0 The anatomy of the breast……………………………………        9

2.1 Size and shape of the breast………………………………….       9

2.2 Location of the breast…………………………………………..       9

2.3 Commonest site for breast lesions…………………………..       10

2.4 Clinical presentations of breast lesions………………………    10

2.5 Benign breast lesions can be characterized ……………….     12

2.6 Malignant lesions can be characterized      ………………….    16

2.7 Breast cancer seen in mammogram has the stages………     18

2.8 Implications of breast screening program on mammogram.19

2.9 How it works…………………………………………………………   20

2.10 Criticisms of mammography……………………………………  21

2.11 How ultrasound evaluate abnormal changes in mammography……………………………………………………………  21

2.12 How magnetic resonance imaging evaluate abnormal changes in Mammography………………………………………..        22

2.13 Indications for using MRI for screening…………………. 23

2.14 How computed tomography evaluate abnormal changes on mammogram……………………………………………………………     23

2.15 The use of biopsy to evaluate abnormal change on mammography…………………………………………………………      24

2.16 There are two procedures during biopsy…………………      24

2.17 Breast biopsy with an ABBI (advanced Breast biopsy instrumentation)………………………………………………………      25

CHAPTER THREE

3.0 Research design……………………………………………………    27

3.1 Source of data………………………………………………………    27

3.2 Sample size…………………………………………………………     27

3.3 Method of data collection…………………………………………   27

3.4 Data analysis………………………………………………………     27

 

CHAPTER FOUR

4.0 Data presentation and analysis ………………………………     28

 

CHAPTER FIVE

5.0 Discussion……………………………………………………………  34

5.1 Conclusion……………………………………………………………  36

5.2 Recommendation……………………………………………………  36

5.3 Limitation…………………………………………………………….   37

5.4 References……………………………………………………………   38

 

CHAPTER ONE

1.0 INTRODUCTION

Cancer can be defined as an abnormal and uncontrolled growth of cell in any part of the body.  Breast cancer is a cancer that affects the breast. The vast majority of breast cancer occurs in women, although man can develop breast cancer too but it is prognosis is rare. A breast tumuor is considered as benign if it is limited to a few cell layers and does not invade surrounding tissue or organs. When the tumour spread to the surrounding tissue or organs, it is considered as malignant1.

Cancer of the breast is the commonest female malignancies in Nigeria 1,2,3,4.  It is the leading cause of cancer related death5 and account for almost one in every five of all cancer related death among women6.  There are widely used effective screening techniques that enhance early detection of breast cancer. These screening techniques include mammography, MRI, thermography and radionuclide imaging4.

Mammography though with its limitations has remained the best and most reliable procedure for early breast cancer detection, this is due to its availability and cost. Mammography is the soft tissue examination of the breast.  The invention of these techniques has actually simulated application of other procedures to breast lesion detection. These screening techniques detect the early stage of breast cancer, that pre-invasive stage, the symptom free stage, the carcinoma-in situ and the curable stage of breast cancer. Breast lesions are dreadful only when the detection and treatment is late3.

Radiographer and radiologist are expected to be familiar with the mammographic appearance of a variety of unusual breast lesions7.  These lesions include systemic diseased e.g. collagen vascular disease, vasculitis, hyperparathyroidism, stectocystoma multiplex, rare benign tumor (e.g. fibromatosis, extra-abdominal desmoids tumour, granular cell tumour) hamartoma (Fibrroadenolipoma), phyllode tumour (cystosarcoma phyilodes), uncommon primary malignant tumors (e.g. lymphoma, sarcoma and carcinosarcoma, adenoid cystic carcinoma), and metastatic lesions.

The most common breast problems for which women and few men consult a physician are breast pain, nipple discharge and palpable mass8.  Breast lesions seen in mammography include lumps, benign tumor, and malignant (metastasis) tumor.

Breast carcinoma is very dreadful disease, therefore there is need that it should be detected at an earlier stage when it prognosis are still high.

There has not been any work in our locality on characterization of breast lesion seen on mammo hence, this research intends to characterize and comprehensively document the breast lesions that are seen in our locality and the age of presentation.  This will help in selecting the most appropriate treatment option for the lesions.

 

1.1 STATEMENT OF PROBLEMS

 

  1. It has been observed that variety of breast lesions seen in mammography at University of Nigeria Teaching Hospital Enugu have not be characterized and comprehensively documented.

2    The age distribution at the time of presentation of the breast lesions has not been documented in our locality.

 

1.2 PURPOSE OF THE STUDY

 

  1. To characterize the breast lesions seen during mammography at UNTH
  2. To establish the age distribution of lesions at the time of presentation.

 

1.3 SIGNIFICANCE OF THE STUDY

  1. The research would be of immense help to clinicians and surgeons, in assessing the common lesions seen in our locality.
  2. It will help the clinicians in selecting the most appropriate diagnostic options for suspected breast lesion.

 

1.4 SCOPE OF THE STUDY

This study cover patient in University of Nigeria Teaching Hospital Enugu, who have undergone mammography.

 

1.5 LITERATURE REVIEW

Breast lesions is the most common form of malignancy affecting women in the world with studies showing that one in every sixteen women will develop the disease in her life time9.

  Statistic had shown that about 28,000 women die from this disease every year10,11.

            The Multside12 clinical study in characterization and differentiation of benign and malignant lesions, out of 179 cases studied in his departmental laboratory, He found that 47% were benign which sub divided into 11 categories and 53% were malignant lesions and had 7 categories but are more common.

In a research done among female teachers in Lagos by Lellan etal13, to investigate their knowledge about the symptoms of breast cancer, 85% knew it was a serious disease but 53.2% knew breast lump as the most commonly recognized sign, ¼ of the participants were said to possess a satisfactory knowledge of breast cancer. It was concluded they had a poor knowledge.

A study carried out by the Health Insurance plan of New York by Egan14, he found that the breast lesions detection and demonstration projected about 10,000 women for breast screening with mammography, and physical breast examination showed that mammography detects breast lesions more at an earlier stage than physical examination.

Moskowitz15 noted on his research that critical understanding of the difference between detection and diagnosis in characterization of breast lesion is necessary for the proper use of mammography and other breast imaging techniques.  He stated clearly that detection is the process of finding breast abnormalities that may be cancerous while diagnosis is the process of finding which of the abnormalities are not cancerous.

According to the archives of internal medicine16, the mammography centers in United Kingdom are not enough to cater for teaming population that go for mammography investigation. In their research in year 2008, 260,000 women were to be diagnosed for breast cancer but only 180,000 received prompt diagnosis. 40,000 patients out of the number that were not diagnosed promptly later died. Mammography facilities are necessary for prompt diagnosis.

Jemel etal17, his research on comparing the breast lesions incidence on white and black, he said that in the black population, it was estimated that one in 50 women would develop breast lesions by the age of 40 and above-with the highest incidence to be benign cases at age of 34 to 44 years and malignant at older age. He also found out that in white population, benign is more common from 45 to 50years and occur in one out of 100 people.  Therefore, it can be concluded that black women become burdened from this disease when compared with white women.

Banjo etal18 in his work on histopathological pattern of breast diseases, he said that breast lesions have actually become the most common lesions among the women. Unfortunately, majority of Nigerians’ breast lesion patients present with advanced disease because of poor diagnosis due to lack of awareness, while patient in the developed world would present early breast lesion, Africa being a developing continent still remains a repository of advanced carcinoma.

A study conducted by WHO19, shows that early detection of breast lesions through mass breast screening has been introduced in many countries of the world including Nigeria, hoping to reduce mortality and aggressive treatment. Till today, mammography has been the best proven methods of early detection of breast cancer.

Orel etal20 noted the complementary role of physical breast examination in detection of breast cancer recurrence after lumpectomy and irradiation even though all cases of purely carcinoma in-situ were solely detected by mammography. Certainly, the earlier detection created by mammography screening implies a reduced tumour burden and better opportunity for immune suppression thus making present and hopeful future therapies more likely to succeed.

Odusanya21 carried out a survey which examined the knowledge, attitude and practice of female school teachers concerning breast lesions: About 200 school teachers were involved in the survey carried out in Lagos Nigeria, with response rate of 94%. A questionnaire was used to investigate their knowledge about the symptoms of breast lesions, method of diagnosis, risk factors and breast self examination. About 52.2% knew breast lump is a recognizable lump. Only 13.8% knew the method of diagnosis and knowledge of risk factors has also been poor. Breast self examination was practiced by 62%, only one quarter of respondent were categorized as possessing satisfactory knowledge of breast lesions. Thus the level of awareness is low among the female school teachers.

Omotosho22 on his research on diseases in Africa, he said that breast screening is the best approach to curbing the menace caused by breast lesions but that the main set back for its use in Africa is culture. Africans are deeply rooted in their culture, assigning almost all illness to a god.

According to Anieebue etal23 in a detail report on the practice of cancer screening among female health workers, inadequate information about modalities and benefit of cancer screening have adverse effects on the women. Breast lesions are a very dreadful disease and there is every need that it should be detected at every stage when its prognosis is still very high.

In a research by Gallup organization24 on 62,000 women age 40-64years to determine the effect of periodic screening, 78% of these women had a first annual re-examination, 73% had a second annual re-examination and 69% had all annual re-examination. The result showed a 30% death in women who had all annual re-examination while the rest control group had about 85% death rate recorded.

Orel etal25 noted the complementary role of physical breast examinations in the detection of breast lesions, recurrence after lumpectomy and irradiation even though all cases of purely in-situ cancers were sole detected by mammography.

In a study by Wasif et al26, MRI was found to be more accurate than ultrasonography or mammography in determination of the size of a breast cancer mass, they found out that of the 61 breast cancers which were evaluated by the 3 modalities, the Pearson correlation coefficient for MRI, was highest [0.80;] followed by ultrasonography, 0.57; and then mammography 0.26 the mean tumor size was 2.1cm by mammography, 1.73cm by ultrasonography, 2.65cm by MRI.

A 2011 cochrane review27 that mammography can be used to detect breast cancer which are as small as 0.5cm in diameter which normally not have been palpated. So mammography has remained the most important tool in breast screening centers for a means of detecting cancer of the breast.

Rahbar et al28 in his study on characterization of breast lesions, confirmed that certain sonographic features can help differentiate benign from malignant masses, but because of inter-observer variability, they concluded that these features should not be generally applied to defer biopsy until additional investigations in a variety of practices are taken.

The association of Radiographers in Nigeria (ARN)29 in their 25th annual conference themed “Radiography in the management of breast diseases and characterization” stressed the need of the federal government of Nigeria to adopt a national policy on breast screening. This profsessional body is also responsible for the use of low Kv x-rays in breast screening. Osunkiyesi.           

 

 

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